Determinants of bile formation during development: ontogeny of hepatic bile acid metabolism and transport.

The studies cited in this brief review stress that the development of hepatic transport processes is extraordinarily complex. Important changes in hepatic morphology and synthetic capacity are required before maturation of membrane carriers for bile acids. Transport systems at both poles of the hepatocyte develop independently. An increase in bile acid synthesis at several stages during the development appears to be an ontogenic event that is programmed to occur in concert with functional maturation of the enterohepatic circulation. Expression of specific membrane transporters for bile acids can be observed in fetal liver and postnatal ileum during periods of expansion of the bile acid pool. It is likely that specific defects, such as congenitally absent or defective bile acid transport proteins, will eventually be discovered in rare patients with undefined cholestatic syndromes. The absence of active ileal bile acid transport has recently been demonstrated in several children with congenital bile acid malabsorption. Whether bile acids can actually induce or regulate production of their own carriers during development has not been determined, but an increase in bile acid pool through feeding of exogenous bile acid has been shown to stimulate an increase in plasma membrane carriers for bile acids in adult rat liver. Thus, a number of factors, including available driving forces for transport, bile acid pool size and composition, effectiveness of intracellular compartmentation and transfer, and the function of membrane carriers, can all contribute to low rates of bile flow and bile acid secretion, depending on the stage of development.